P - 78340REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � m Minnesota Board of Electricity
w� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity. state. mn. us
Identity the work covered by this request: /'Q,�a . e . � ��/+� 6
�t 0 / �
❑NEW ❑REMODEL d�kDDITION �REPAIR �Q � NE �iQU ✓►'�: 1� o �`
GENERAL FEES Outdoor Lighting Standard �$1
" 0 to 400 Am ere �$25 QG /' su iementai ree �e �zu
401 to S00 Am re �$50 llNnsformers u to 10 KVA �$10
Above 800 Am re�$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su tor Si ns / OuUine Li htin � E5
0 to 200 Am re �$5 -►.. �— ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unil �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTA� �E i
3 to i2 Units �$50 Per Unit (minimum total fee is $20) ��y 0
Each Additional Unit �$25 �� A�°`� ,�C�1- �e.w� u` s �j
OTHER ADDITIONAL FEES .� �� G�'�� j� "�
Li htin Retrofit �$z5 r Fxlure � /C�(��lj 1� /z-r—��'"a �
Center Pivot Irri tion Boom �$40 �„�g�, �-�/��n �„ ��.� n- ,(�• c
Manuf3Ctur6d HOnte Pafk IAtS �$25 I here ceAify that I inspected the elechical installa6on described herein on the datas �:
�m wre
Recreational Vehicle Park Sites � $5 �,�7��
S rete Bondin In ection �$20
S ial In 'on � $30 r Hour � ' � "y"'�"`�fON /� �"�
S cial I 'on �$.31 r Mile (�l ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COA�PLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
I II�III lllll Illll IIIII IIIII IIli1lllll iIIN 1111II11 `� /��j
�
�E 1 3 4 7 3 1 7 S 3E �` �/� °
r
Request Date: Rough-in InspecUon Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
�^ � You must call the inspector when eadyl Date Ready:
i certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at